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首页> 外文期刊>Asian journal of surgery >Non-operative treatment outcome for rectal cancer patient with clinical complete response after neoadjuvant chemoradiotherapy
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Non-operative treatment outcome for rectal cancer patient with clinical complete response after neoadjuvant chemoradiotherapy

机译：新辅助放化疗后临床完全缓解的直肠癌患者的非手术治疗结果

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BackgroundAmong rectal cancer patients, some of good responders after neoadjuvant chemoradiotherapy (nCRT) are considered for non-operative treatments to avoid postoperative morbidities and permanent stoma. However, oncologic feasibility of non-operative treatment has not been fully understood.MethodsFrom 2008 to 2017, we retrospectively reviewed patient's records who had lower or mid rectal cancer and diagnosed to clinical complete response by magnetic resonance imaging after nCRT. Clinical differences and oncologic outcomes were compared among Radical surgery (RS), Local excision (LE) and Wait-and-see (WS) group.ResultsNumber of 129, 25, 15 patients included to RS, LE, WS groups. Local recurrence was frequent type of recurrence in both of LE and WS group (RS; 31.3%, LE; 80%, WS; 66.7%), and many patients in WS group omitted salvage treatment (RS; 75%, LE; 100%, WS; 33.3%). 5-years local-recurrence/disease-free survival rate (LRFS, DFS) between RS and LE were similar between each group, but WS showed significantly inferior outcomes than that of RS (LRFS; p?=?0.001, DFS; p?=?0.001). In multivariate analysis, WS protocol (OR; 7.163, 95% CI; 1.995–25.715) and cT4 stage (OR; 8.206, 95% CI; 1.596–42.198) were independent factors for LRFS.ConclusionsWait-and-see group showed high rate of rejection of salvage treatments for recurrence, and poor oncologic outcomes. However, recent low-level evidences reported favorable outcome of WS protocol when salvage treatment was followed after recurrence. It seems that the application of WS protocol should be postponed until the results of randomized-controlled trials are available. Local excision seems to be good alternative option to radical surgery when salvage treatment is followed.
机译：背景在直肠癌患者中，考虑将一些新辅助放化疗后的良好反应者用于非手术治疗，以避免术后并发症和永久性气孔。方法2008年至2017年，我们回顾性回顾了患有直肠中低位癌的患者病历，并通过nCRT后的磁共振成像诊断出对临床完全缓解的诊断。比较了根治性手术（RS），局部切除（LE）和观望（WS）组之间的临床差异和肿瘤学结局。结果129、25、15例患者分为RS，LE，WS组。 LE和WS组均为局部复发（RS; 31.3％，LE; 80％，WS; 66.7％），并且WS组中许多患者省略了挽救治疗（RS; 75％，LE; 100％ ，WS; 33.3％）。两组之间RS和LE的5年局部复发/无疾病生存率（LRFS，DFS）相似，但WS的结局显着低于RS（LRFS; p <= 0.001，DFS; p？）。 = 0.001）。在多变量分析中，WS协议（OR; 7.163，95％CI; 1.995–25.715）和cT4分期（OR; 8.206，95％CI; 1.596–42.198）是LRFS的独立因素。拒绝挽救治疗方法以防止复发和肿瘤治疗效果差。但是，最近的低水平证据表明，复发后进行抢救治疗时，WS方案的预后良好。似乎应该推迟WS协议的应用，直到获得随机对照试验的结果为止。当进行抢救治疗时，局部切除似乎是根治性手术的替代选择。

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